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How to get relief from urinary incontinence: many treatment options, including quick, minimally invasive procedures, can help stop urine leakage.

Millions of women have urinary incontinence (UI), but many have a compromised quality of life because they are embarrassed to talk about the condition with their doctors, it may help to know that if you do have urine leak age, you have plenty of company.

In women over age 50, there is a 30 to 35 percent prevalence of UI," says Renuka Tyagi, MD, assistant professor of urology at Weill Cornell Medical College. "It is a quality of life issue; it impacts women's professional and personal lives, sometimes to an extreme degree. As the frequency and volume of UI increases, women withdraw from activities, or they are worried all the time. For some, it inhibits sexual activities as well."

Dr. Tyagi understands that this may be difficult to discuss, but she urges you to speak up if you have UI: "Women need to know about minor interventions that take as little as 15 minutes; there are several minimally invasive procedures that can tremendously reduce or cure UI."

Types of UI

Urinary incontinence--the involuntary release of urine--occurs if your bladder muscles contract without warning or if the muscles surrounding your urethra, the tube through which urine exits your body, are too weak to stop the flow of urine. Types of UI include:

* Stress incontinence: You leak urine when you laugh, cough or sneeze.

* Urge incontinence: The bladder contracts without warning, which causes urine leakage; this is sometimes referred to as "overactive bladder." This type of incontinence can occur with stress incontinence; rarely, its an early sign of bladder cancer.

* Functional incontinence: You leak urine because you can not get to the bathroom quickly enough.

The different types of incontinence respond to different treatment strategies, so it is important to identify which type you have. Your doctor may ask you to keep track of how much you drink, and when and how much you urinate, for several days. Your doctor also may order urine and blood tests, a test that measures how well your bladder empties, an ultrasound scan, or a cystoscopy, which examines the inside of the bladder and urethra.

Treatment options

Several behavior modifications can help alleviate UI.

"Women can look at what, when, and how much liquid they are drinking to determine if their beverage consumption is a factor. They can do Kegel exercises, which help strengthen the pelvic floor muscles. And, for some women, timed voiding [setting a schedule of specific times for urinating] can help," explains Dr. Tyagi.

If these behavioral strategies are not effective, medications, physical therapy and/or biofeedback may be employed.

To stop muscles from involuntarily contracting, medication can be injected into the bladder or urethra. "Botox is one such drug used for urge incontinence, but not for stress incontinence; it also can be very effective for women with other spastic pelvic disorders," says Dr. Tyagi.

For stress incontinence, bulking agents may be administered via injection into tissues around the urethra, which thickens the tissues and helps narrow the bladder opening. These procedures are usually done in the doctor's office and require minimal anesthesia.

Women with stress incontinence that hasn't responded to other treatments may opt for a sling procedure, which entails insertion of a mesh sling that supports the urethra and part of the bladder. This helps keep the urethra closed and prevents leakage when laughing or coughing. An option for urge incontinence involves implantation of a nerve stimulation device that delivers weak electrical impulses to nerves that control the bladder. Both of these procedures are often performed on an outpatient basis under local anesthesia.

Dr. Tyagi says that other treatment options may be available in the near future, since there is a great deal of ongoing research for UI treatments.

Consuit a doctor

If you don't feel comfortable discussing UI with your primary care doctor, consult a urologist or a uro-gynecologist; these doctors specialize in treating UI.

"Even if you feel the bother of UI isn't a problem, you should tell your doctor, so you can be screened to ensure that the underlying cause is not infection or cancer," advises Dr. Tyagi.



Identify your pelvic floor muscles while urinating by squeez ing the muscles to slow down or stop your urine flow. These are the muscles you will be exercising.

Do one set of Kegel exercises three times a day. If possible, j vary your position (sitting, standing, lying down) when doing the exercises. However, don't do them while sitting on the toilet because it couSd create voiding problems.

For your first set, do slow contractions: Squeeze your pelvic floor muscles; hold for 5 to 10 seconds, then release. Repeat 30 times, pausing for one second between repetitions.

For your second set, do a set of 30 rapid contractions, squeezing for one second, then releasing for one second.

For your third set do a set of 30 slow contractions, just like your first set.
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Title Annotation:TREATMENT
Publication:Women's Health Advisor
Date:Dec 1, 2011
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